Jacqueline Bernadine Petravage in Salt Lake City - Psychiatry
Jacqueline Bernadine Petravage - NPI 1104861079
Jacqueline Bernadine Petravage is a Psychiatry in Salt Lake City, Utah. Jacqueline Bernadine Petravage practices all healthcare services and medical treatments related to Psychiatry. The NPI Number for Jacqueline Bernadine Petravage is 1104861079. The last update date is 2007-07-08.
Jacqueline Bernadine Petravage's current location address is 500 Foothill Blvd, Salt Lake City, Utah. You can contact this provider via phone number 8015821565 and fax number 8015842544. The mailing address for Jacqueline Bernadine Petravage is 500 Foothill Blvd, Salt Lake City, Utah. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Jacqueline Bernadine Petravage |
|---|---|
| Address | 500 Foothill Blvd, Salt Lake City, Utah |
| Phone Number | 8015821565 |
| Fax Number | 8015842544 |
| Sole Proprietor | X |
| Credentials | M.D. |
NPI Number Detail
| NPI Number | 1104861079 |
|---|---|
| Provider Enumeration Date | 2006-06-17 |
| Last Updated Date | 2007-07-08 |
Provider Mailing Address Detail
| Address | 500 Foothill Blvd |
|---|---|
| City | Salt Lake City |
| State | Utah (UT) |
| Post Code | 841480001 |
| Phone Number | 8015821565 |
| Fax Number | 8015842544 |
Provider's Primary Taxonomy Detail
| Speciality | Psychiatry |
|---|---|
| Taxonomy | 2084P0800X |
| Licence No | 1664161205 |
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Definition: A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment |
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Post Comment/ Review Below
What is the unique provider identifier assigned to Jacqueline Bernadine Petravage?
The Jacqueline Bernadine Petravage has been issued the NPI (National Provider Identifier) 1104861079 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code is a unique identification number for healthcare providers.
Can you provide the Jacqueline Bernadine Petravage's physical address?
The Jacqueline Bernadine Petravage is physically located at 500 Foothill Blvd, in the city of Salt Lake City, UT, with the postal code 841480001.
What is Jacqueline Bernadine Petravage's primary area of medical expertise, and what taxonomy classification code corresponds to this specialized field?
The primary area of medical expertise for Jacqueline Bernadine Petravage is Psychiatry, and the corresponding taxonomy classification code for this specialized field is 2084P0800X.
On what date did Jacqueline Bernadine Petravage receive its 1104861079 assignment from the Centers for Medicare & Medicaid Services?
The Jacqueline Bernadine Petravage was assigned its 1104861079 on 2006-06-17, which is the date when this unique identifier was issued to the organization by the Centers for Medicare & Medicaid Services.
As of what date was the information pertaining to Jacqueline Bernadine Petravage, such as address, specialty, and other details, last reviewed and confirmed to be accurate?
The information related to Jacqueline Bernadine Petravage, including its address, specialty, and other relevant details, was last reviewed and confirmed to be accurate on 2007-07-08.
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